title: Endoscopic and histological pitfalls in the diagnosis of celiac disease: A multicentre study assessing the current practice.
abstract: OBJECTIVE
  the diagnosis of celiac disease requires small bowel biopsies to identify the characteristic mucosal changes. The current biopsy practice among endoscopists for celiac disease is in most part unknown. The aim of this study was to compare the different diagnostic policies in various centers in their current practice.
  
  
  METHODS
  information from a total of 931 confirmed celiac disease patients was retrospectively obtained retrospectively from nine centers in European and Middle Eastern countries. The number of small-bowel biopsies obtained from the duodenal bulb and the second part of the duodenum was compared among different centers.
  
  
  RESULTS
  the most frequent stage of mucosal changes amongst Iranian subjects was Marsh IIIa whereas in the rest of the study population was Marsh IIIc. Marsh I and Marsh II were more prevalent in adults (P < 0.05) and Marsh IIIc was significantly higher in pediatric ages between 1 and 15 (P < 0.05). The most common number of biopsy specimens obtained from Romanian subjects was 1 (52% of cases), followed by 2 for Iranian (56%), 3 for Lithuanian (66.7%) and British patients (65%) and 4 for Italian patients (48.3%). For majority of cases, anemia was the most prevalent symptom (18.7%) followed by malabsorption (10.5%), diarrhea (9.3%) and dyspepsia (8.2%), respectively.
  
  
  CONCLUSIONS
  despite the evidence-based recommendations, this study revealed a poor compliance with major guidelines on diagnosis of celiac disease. We emphasize that taking adequate number of duodenal biopsies should be implemented for an accurate diagnosis and also for the exclusion of celiac disease.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Rostami-Nejad
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Villanacci
authors.forename: Sabine
authors.initials: S
authors.lastname: Hogg-Kollars
authors.forename: Umberto
authors.initials: U
authors.lastname: Volta
authors.forename: Stefania
authors.initials: S
authors.lastname: Manenti
authors.forename: Mohammad
authors.initials: M
authors.lastname: Reza-Zali
authors.forename: Giacomo
authors.initials: G
authors.lastname: Caio
authors.forename: Paolo
authors.initials: P
authors.lastname: Giovenali
authors.forename: Ausrine
authors.initials: A
authors.lastname: Barakauskiene
authors.forename: Edita
authors.initials: E
authors.lastname: Kazenaite
authors.forename: Gabriel
authors.initials: G
authors.lastname: Becheanu
authors.forename: Mircea
authors.initials: M
authors.lastname: Diculescu
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pellegrino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Magazzù
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casella
authors.forename: Camillo
authors.initials: C
authors.lastname: Di-Bella
authors.forename: Nicola
authors.initials: N
authors.lastname: Decarli
authors.forename: Mauro
authors.initials: M
authors.lastname: Biancalani
authors.forename: Gabrio
authors.initials: G
authors.lastname: Bassotti
authors.forename: Kamran
authors.initials: K
authors.lastname: Rostami
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002446:Celiac Disease / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult